Nonstandard treatment of endometrial cancer in patient in a procreative age wishing to keep fertility-case report

Abstract

Introduction: Endometrial cancer is the most common malignant neoplasm of female reproductive organs that develops from the lining of the womb. The peak incidence falls on the 5th decade of life. Diagnosis of endometrial cancer in young women under 30 years of age is very rare. Detection of cancer at such a young age is an extremely difficult case, because the treatment must consider the reproductive plans of patients so that they can maintain important fertility for them. Case report: In 2018, a 25-year-old patient was admitted to the Clinic of Oncological Gynaecology and Gynaecology to treat endometrial cancer in FIGO IB. The operation involving the removal of the uterus with fallopian tubes was rejected due to the young age of the patient and her reproductive plans. Prior to hospitalization, the patient was offered the possibility of hormonal treatment that saves fertility. After presenting a 6-month regimen of hormone therapy with medroxyprogesterone acetate (MPA), using a levonorgestrel-releasing intrauterine device, the patient refused consent for its implementation for personal reasons. The patient was proposed to perform electroresection of the endometrial polyp, fractionated erosion of the cavity and cervical canal during hysteroscopy. However, it was marked that it’s possible to not completely remove the cancer during the procedure. The patient agreed to this therapeutic procedure. The procedure was performed without any complications. Quarterly cytological control tests and bi-annual endometrial biopsies are correct and for over a year, there is no recurrence of endometrial cancer and the patient is feeling well. Conculsion: Electroresection of endometrial changes during hysteroscopy in endometrial cancer can be a promising therapeutic option in the early stages of endometrial cancer (FIGO I) in women who want to maintain fertility. However, this requires further validation. It should be remembered that the occurrence of endometrial cancer at such a young age may be a component of genetic syndromes such as Lynch syndrome. Patient awareness of possible relapses and emphasis on quick response in case of disturbing symptoms is extremely important in order to detect a recurrence as quickly as its possible, and thus extend the patient's life, maintaining its good quality.

Keywords

• endometrial cancer
• fertility
• conservative treatment